[Acute glomerulonephritis associated with Mycoplasma pneumonia]. / Uminis glomerulonefritas, susijes su mikoplazmine pneumonija.

A rare case of acute glomerulonephritis associated with Mycoplasma pneumoniae pneumonia is described. Although various types of renal damage associated with Mycoplasma infection have been reported in medical literature, kidney disease resembled classical postinfectious glomerulonephritis in this case. Possibly, the only difference was that the first signs of kidney disease almost coincided with symptoms of respiratory tract infection, instead of appearing at least a week later. The clinical course and outcome of the kidney disease were favorable.

Influenza vaccine concurrently administered with a combination measles, mumps, and rubella vaccine to young children.

Children aged 11 to <24 months received 2 intranasal doses of live attenuated influenza vaccine (LAIV) or placebo, 35+/-7 days apart. Dose 1 was administered concomitantly with a combined measles, mumps, and rubella vaccine (Priorix). Seroresponses to measles and mumps were similar between groups. Compared with placebo, response rates to rubella in LAIV+Priorix recipients were statistically lower at a 15 IU/mL threshold (83.9% vs 78.0%) and the prespecified noninferiority criteria were not met. In a post hoc analysis using an alternate widely accepted threshold of 10 IU/mL, the noninferiority criteria were met (93.4% vs 89.8%). Concomitant administration with Priorix did not affect the overall influenza protection rate of LAIV (78.4% and 63.8% against antigenically similar influenza strains and any strain, respectively).

Renal amyloidosis in a child with chronic granulomatous disease and invasive aspergillosis.

A boy who had been diagnosed with chronic granulomatous disease (CGD) at the age of 6.5 years had a medical history of multiple bacterial infections, including pneumonia, staphylococcal liver abscesses and septicemia, from birth. At the age of 10 years and 4 months he developed an infection that was accompanied by high fever and pulmonary, mediastinal and paravertebral infiltrations. Aspergillus niger was cultured on bronchial secretions obtained by bronchoscopy. Shortly thereafter, proteinuria manifested and progressed to the nephrotic level. A skin biopsy indicated a diagnosis of amyloidosis. An anti-fungal treatment with amphotericin B and other agents, along with surgical pus drainage, intravenous leukocyte mass, interferon-gamma and immunoglobulin infusions, was ineffective, and the patient eventually died from multi-organ failure. The postmortem examination revealed the presence of disseminated aspergillosis and systemic amyloidosis. Although no direct evidence is available that would confirm the causative role of aspergillosis in the development of systemic amyloidosis, to the best of our knowledge this is the first report of a CGD case with complications of both invasive aspergillosis and systemic amyloidosis.

[Nephrogenic diabetes insipidus in a large family]. / Keliu dideles seimos nariu paveldetas inkstu necukrinis diabetas.

Hereditary nephrogenic diabetes insipidus is a rare disease. We describe here three brothers with this disease from a big family consisting of 10 siblings. The case is undoubtedly X-linked because the sufferers are only boys, one of them with a different father. The illness was noticed rather late, namely, at the ages of approximately 7, 6 and 5 years. Possibly, this is a particular characteristic of this family, because the disease is usually diagnosed before the age of two years. In the oldest brother (at present 15 years old) epicystotomy was performed at the time of diagnosis because of polyuria, hydroureteronephrosis and bladder hypotonia; the intervention caused a urinary tract infection leading to chronic pyelonephritis and renal scarring. No urologic intervention was necessary in the younger brothers, because their illness was noticed and treatment started somewhat earlier. This case shows that polydipsia and polyuria should always be assessed properly to disclose their causes.

[Hemolytic-uremic syndrome in Lithuania over the period 1990-2004]. / Vaiku sergamumas hemoliziniu-ureminiu sindromu Lietuvoje (1990-2004).

More than 80 cases of the hemolytic-uremic syndrome were registered in Lithuania over the period 1990-2004. The incidence of this syndrome fluctuated annually; higher incidence rates were observed in 1990-1993, 1998-1999 and 2003-2004, however, there was no overall increase in morbidity over the 15-year period. Most cases occurred in the first two years of life; besides, girls suffered slightly more often than boys. At least in 80% of cases the illness was typical, i.e. was associated with diarrhea. In general, the data correspond to the findings of other scientists.

Comparative study of prednisolone alone and prednisolone plus fusidic acid in the treatment of children with steroid-responsive nephrotic syndrome.

BACKGROUND: There are several reports in the literature indicating that fusidic acid owns functions similar to those of cyclosporin. As cyclosporin has effectively been used in frequently relapsing steroid-responsive nephrotic syndrome we carried out this study to determine whether fusidic acid used along with prednisolone diminishes rate of steroid-responsive nephrotic syndrome relapses in children. PATIENTS AND METHODS: The patients were randomly allocated to receive either prednisolone alone or prednisolone plus fusidic acid for two months in standard doses. In the cases of relapses the treatment was changed to the comparative treatment method. Altogether 18 children (12 boys and 6 girls) aged 1.3 to 13.2 years entered the study. Thirteen of them were treated by either method on different occasions, four patients were treated with prednisolone only, and one child was treated with prednisolone plus fusidic acid only. Thus, there were 17 evaluable treatment courses with prednisolone alone and 14 courses with prednisolone plus fusidic acid. The patients were followed-up as long as the remission lasted. RESULTS: There was prompt and complete response under the influence of both treatment methods. However, relapses occurred in all the patients irrespective of the mode of treatment. Mean duration of remissions did not differ significantly between the study groups (17.8+/-20.4 weeks in the prednisolone group and 18.3+/-23.9 weeks in the prednisolone plus fusidic acid group; p>0.05). There were no statistically significant differences in laboratory parameters reflecting therapeutic efficacy in the comparative treatment groups, too. CONCLUSION: Thus, it was not revealed any remission-sustaining efficacy of fusidic acid used in standard doses for two months along with prednisolone in children with frequently relapsing steroid-responsive nephrotic syndrome.

Slow progressive FSGS associated with an F392L WT1 mutation.

Constitutional missense mutations in the WT1 gene are usually associated with the Denys-Drash syndrome, characterized by a rapid progressive nephropathy, male pseudohermaphroditism, and an increased risk for Wilms tumor. We report here a patient with scrotal hypospadias and a slow progressive nephropathy due to focal and segmental glomerulosclerosis. WT1 mutation analysis revealed a constitutional missense mutation in exon 9 resulting in an exchange F392L. This mutation has previously been reported by others in a patient with a similar mild course of nephropathy. In contrast, a mutation in the corresponding codon of exon 8 (F364L) was previously found by us in a patient with a very rapid progression to end-stage renal disease. Whether the position of a mutation may influence the course of the nephropathy must be evaluated in a larger patient cohort. The individual tumor risk for this alteration cannot be given at present because neither of the two patients has shown evidence of a Wilms tumor or a gonadoblastoma to date.

[BK virus-associated nephropathy]. / BK virusine nefropatija.

BK virus was first detected more than 30 years ago, however its role long time was not exactly defined. The virus is usually acquired in childhood; seroprevalence rate in adults appears to be 60-80%. In most cases the infection is asymptomatic. After renal transplantation it may manifest as so-called BK virus-associated nephropathy by gradual decrease of allograft function or signs of acute rejection. There is no effective therapy of BK virus-associated nephropathy to date. Treatment with low-dose cidofovir is under investigation.

[Influence of omega-3 fatty acids on lipid metabolism in children with steroid sensitive nephrotic syndrome]. / Omega-3 riebalu rugsciu itaka steroidams jautriu nefroziniu sindromu serganciu vaiku lipidu apykaitai.

Changes in lipid metabolism is one of the most important features of steroid sensitive nephrotic syndrome. Increased serum lipid level not always is connected with disease activity and sometimes may persist for long time, especially in frequently relapsing nephrotic syndrome. Hyperlipidemia and dyslipidemia are connected with cardiovascular diseases and development of glomerulosclerosis. Omega-3 (omega-3) polyunsaturated fatty acids have positive influence on lipid metabolism, diminishing hypercoagulation and a risk of cardiovascular diseases. The aim of this study was to examine influence of omega-3 polyunsaturated fatty acids on lipid disturbances in children with steroid sensitive nephrotic syndrome. Forty-eight patients were included in the study; 24 of them were treated with prednisolone (control group) and 24 were treated with prednisolone and fish oil (6 mg/day) along with symptomatic therapies. Serum lipid profile and spectrum of fatty acids before treatment and three months after start of the treatment were evaluated. Before treatment, contents of serum fatty acids and lipids did not differ between the groups. The study showed decrease in serum triglycerides (p<0.06) and omega-6 polyunsaturated fatty acids (p<0.02), increase in concentration of omega-3 polyunsaturated fatty acids and the ratio of 20:5 omega-3/20: omega-6 (eicosapentaenoic/arachidonic acids) (p<0.001). Cholesterol, HDL-Ch, LDL-Ch concentrations did not change under the treatment with fish oil. We conclude that fish oil might be useful as an agent normalising lipid metabolism in children with steroid sensitive nephrotic syndrome.

[Urinary microflora in children from different pediatric departments]. / Vaiku slapimo mikroflora, nustatoma skirtinguose pediatrijos padaliniuose.

For rational treatment of urinary tract infection it is necessary to know the causative agents. These may be different in various departments of health care institution managing patients with different illnesses. The article presents results of urinary cultures performed in 2002 in Microbiology Laboratory of Vilnius University Children's Hospital. The urine specimens were sent to the Laboratory from all departments of the Hospital. The most common isolate in all departments was E. coli (63.1% of all cultures with growth of >/=10(5) cfu/ml). This organism was somewhat less common in urine specimens obtained from Department of Urology (54.8%); accordingly, species of other organisms were isolated somewhat more often. S. aureus most often was identified in urine specimens from neonatal departments (11.1% of all significant isolates). There were no significant differences in urinary microflora isolated from pediatric in-patients and out-patients. Majority of the strains of the main urinary pathogen, E. coli, showed susceptibility to gentamicin, II-III generation cephalosporins, co-amoxiclav, nitrofurantoin and ciprofloxacin. Thus for empirical treatment of urinary tract infection it is necessary to choose an antibiotic with good activity against E. coli. In more complex circumstances (e.g. in children with urinary tract anomalies and in those treated in intensive care units) it would be better to take into account the results of urinary culture and susceptibility testing.

Resistance in respiratory tract pathogens and antimicrobial use in Icelandic and Lithuanian children.

To assess resistance rates among respiratory tract pathogens and antimicrobial usage of children in Iceland and Lithuania, and to correlate usage patterns with resistance rates, nasopharyngeal swabs were taken from healthy children attending day-care centres in Reykjavik (n = 6) and Vilnius (n = 13), and cultured for pneumococci, Haemophilus influenzae and Moraxella catarrhalis. Information about recent antimicrobial use was obtained by a questionnaire. 50% and 51% carried pneumococci, 59% and 67% carried H. influenzae and 60% and 46% carried M. catarrhalis, in Reykjavik (n = 297) and Vilnius (n = 508), respectively. The prevalence of penicillin non-susceptible pneumococci was 11% in Reykjavik (mainly serotype 6B) and 5% in Vilnius (mainly 23F). At the time of sampling 3% of the children in Reykjavik and 8% in Vilnius were receiving antimicrobials. Children carrying penicillin non-susceptible pneumococci had used antimicrobials more frequently in the preceding month and this was significant for the Icelandic children (p < 0.0002). Antimicrobial use was more common in Vilnius than in Reykjavik, yet antimicrobial resistance was more common in Reykjavik. Resistance rates cannot be predicted only on the basis of recent antimicrobial use.